<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
    pageEncoding="ISO-8859-1"%>
<fieldset class="ui-widget ui-widget-content ui-corner-all">
	<legend class="ui-widget ui-widget-header ui-corner-all">Underwriting</legend>
	<div class="modulo200"><label>Insured name  </label><input  id="npnameinsrd" readonly class="text"/></div>
	<div class="modulo200"><label>CPF           </label><input  id="npcpf"       readonly class="cpf"/></div>
	<div class="modulo200"><label>Birth date    </label><input  id="npbirthdate" readonly class="text dtpicker"/></div>
	<div class="modulo200"><label>Vehicle vendor</label><input  id="npvehvendor" readonly class="text"/></div>
	<div class="modulo200"><label>Vehicle model </label><input  id="npvehimodel" readonly class="text"/></div>
	<div class="modulo200"><label>Payment Option</label><select id="nppaymentop" class="combo"><option>Cash</option><option>Credit card</option></select></div>
	<fieldset class="tabela ui-widget ui-widget-content ui-corner-all">
		<legend class="ui-widget ui-widget-header ui-corner-all">Billing Address</legend>
		<div class="modulo200"><label>Street</label><input  id="npstreetbil" class="text"/></div>
		<div class="modulo200"><label>Number</label><input  id="npnumberbil" class="text number"/></div>
		<div class="modulo400"><button id="npbtcpyaddr">Copy address to the risk address</button></div>
	</fieldset>
	<fieldset class="tabela ui-widget ui-widget-content ui-corner-all">
		<legend class="ui-widget ui-widget-header ui-corner-all">Address Risk</legend>
		<div class="modulo200"><label>Street</label><input  id="npstreetrsk" class="text"/></div>
		<div class="modulo200"><label>Number</label><input  id="npnumberrsk" class="text number"/></div>
	</fieldset>
</fieldset>
<p>
	<button id="npbtquoteag">Quote again</button>
	<button id="npbtnwquote">New Quote</button>
	<button id="npbtsubscrp">Subscripe</button>
</p>